Hyperventilation syndrome: symptoms

Among the numerous symptoms of hyperventilation syndrome, there are five leading symptoms:

1. vegetative disorders;
2. changes and disorders of consciousness;
3. musculo-tonic and motor disorders;
4. painful and other sensitive disorders;
5. mental disorders.

The complexity of the symptoms of the hyperventilation syndrome is related to the fact that complaints made by patients are nonspecific. The classical ("specific") triad of symptoms - increased respiration, paresthesia and tetany - only to a minimal extent reflect the richness of the clinical picture of the hyperventilation syndrome. Although a bright hyperventilation crisis (hyperventilation attack) sometimes causes serious diagnostic difficulties, nevertheless it is commonly believed that acute hyperventilation paroxysm is easy to recognize. Low clinical manifestations of hyperventilation crisis or paroxysm are presented.

Paroxysmal symptoms of hyperventilation syndrome

At the same time (or a little later) with a feeling of anxiety, anxiety, fear, most often fear of death, the patient experiences a feeling of lack of air, difficulty breathing, a feeling of chest tightness, lump in the throat. In this case, as a rule, rapid or deep breathing is noted, a violation of the rhythm and regularity of the respiratory cycles. Simultaneously, patients experience unpleasant sensations from the cardiovascular system - in the form of palpitations, a sense of cardiac arrest, irregular work, pain in the left side of the chest. Objectively stated lability of the pulse (most often tachycardia) and arterial pressure, extrasystoles.

In the structure of the crisis most often, almost obligingly, there are three groups of signs forming a certain core: emotional (most often anxious), respiratory and cardiovascular disorders.

Hyperventilation crisis assumes in its structure the presence of a leading phenomenon - excessive, increased breathing. However, many patients do not realize the very fact of hyperventilation, as their attention is riveted to other manifestations on the part of various organs and systems: the heart, the gastrointestinal system, the muscles, ie, the consequences resulting from hyperventilation. If the painful respiratory sensations in the form of shortness of breath, lack of air, etc. Attract the attention of the patient, he relates them more often due to the pathology of the heart. It should be noted that the hyperventilation phenomenon is an integral part of the vegetative syndrome.

Most known researchers of the problem of hyperventilation syndrome believe that acute hyperventilation paroxysms or attacks, as they are usually called, are only a small fraction of the clinical manifestations of the hyperventilation syndrome. Spontaneous tetanic crises (as the most graphic expression of hyperventilation paroxysm) are the "tip of the iceberg" visible on the surface. The "body of the iceberg" (99%) is chronic forms of hyperventilation syndrome. This point of view is shared by most researchers involved in the problem of hyperventilation syndrome.

The most common signs of hyperventilation syndrome have a permanent character, which is manifested differently in different systems.

Vegetative-visceral manifestations of hyperventilation syndrome

Respiratory disorders. It is necessary to distinguish four variants of the respiratory clinical manifestations of the hyperventilation syndrome.

Variant I - syndrome of "empty breathing". The main sensation at the same time is dissatisfaction with the inspiration, a feeling of lack of air and oxygen. In the literature, this phenomenon is referred to as "lack of breathing", a sense of lack of air, "hunger for air". It should be emphasized that the respiratory process itself (and most importantly, it is felt) is completely free. Usually patients claim that they periodically (in 5-15 minutes) need deep breaths to feel fully breathing; while the first time is not always obtained, require repeated deep breaths.

In the process of examining patients, we observed their attempts to produce a "successful" breath, which did not differ in depth from the previous ones, for them they were "unsuccessful." Other patients claim that they "breathe, breathe, can not breathe." This variant of "air bulimia" changes the behavior of patients. The feeling of dissatisfaction with the inhalation gradually fixes the attention of the patients to the "air atmosphere" around them, they do not tolerate the stuffiness, the sense of smell is aggravated, and the smells that previously did not disturb them are constantly hampered and worsened by the state. Such patients constantly open the window, window leaf even in the most severe frosts, i.e. Are mainly engaged in the realization of their "breathing behavior", they become "fighters for fresh air" or, in the figurative expression of the patients themselves, "air maniacs". In addition to the above situations, respiratory sensations are dramatically enhanced in conditions that cause anxiety (examinations, public speaking, transportation, especially metro, altitude, etc.).

Objectively, the breathing of such patients is frequent and (or) deep, often fairly even. However, emotional factors easily violate its regularity.

Option II - the feeling of inferior work of the automatism of breathing, the feeling of stopping breathing. The patients claim that if they do not inhale themselves, then there will not be an automatic self-realization of it. Concerned about this fact, that is, "loss of one's breath" (more precisely, loss of the feeling of the automaticity of Breathing), patients are anxiously watching the completion of the breathing cycle, actively, arbitrarily "including" in its function.

Most likely, the "stopping" of breathing is most likely a sensation of the patients, however, further research will be needed to identify the brain mechanisms of such phenomenon, reminiscent phenomenologically "Ondina's curse" and the sleep apnea syndrome.

Option III - more generalized can be called "a syndrome of shortness of breath." Sensation of lack of air, as in variant I, is also present, but unlike variant I, the act of breathing is felt by the patients as difficult, occurs with great tension. Patients feel a lump in the throat, non-passage of air into the lungs, a sensation of obstruction in the way of air penetration (they most often indicate the level of the upper third of the chest), "squeezing" the breath inside or squeezing outside, the inability sometimes to perform a deep breathing act or moments " tightness "," tightness "of the chest. These painful feelings are poorly tolerated by patients, whose attention (unlike variant I of respiration) is fixed mainly not on the external environment, but on the completion of the respiratory act by him. This is one of those options that were called "atypical asthma." With objective observation, there is also increased breathing, irregular rhythm, use in the act of breathing in the chest. Breathing with the inclusion of additional respiratory muscles, the patient's appearance is restless, tense, focused on the difficulty of performing a respiratory act. Usually objective examination of the lungs does not reveal any pathological signs.

The described variants I and III of respiration retain their pattern both in the situation of the hyperventilation crisis and in the state of permanent dysfunction. In contrast, the variant IV respiratory disorders can disappear in the paroxysmal state of the hyperventilation attack.

Hyperventilation equivalents are periodically observed in patients sighs, coughing, yawning and sniffing. These erased, reduced respiratory manifestations are considered sufficient to maintain prolonged or even permanent alkalosis of blood, which has been proven by special studies. At the same time, some patients often do not realize that they occasionally cough, yawn, deeply sigh. Usually they are indicated by colleagues at work, close people. Such paradoxical forms of hyperventilation syndrome, in which there is no increased respiration in the usual presentation ("hyperventilation without hyperventilation"), are the most frequent forms of hyperventilation syndrome, when the greatest diagnostic difficulties arise. In these cases, apparently, it is a violation of the organization of the act of breathing, a violation requiring minimal respiratory redundancy to maintain prolonged hypocapnia and alkalosis when the reaction of the respiratory center changes by the concentration of CO2 in the blood.

Thus, respiratory dysfunction takes a leading place in the structure of the hyperventilation syndrome. Manifestations of this dysfunction can be a leading complaint in patients with a hyperventilation syndrome, and may be less pronounced and even absent as active complaints.

Cardiovascular disorders

Heart pain among soldiers was known to be those complaints that historically aroused interest in the study of hyperventilation syndrome, first studied in detail and described by the American physician J. Da Costa in 1871. In addition to heart pain, patients usually notice heart palpitations, discomfort in the heart, compression and chest pain. Objectively, the lability of the pulse and arterial pressure, extrasystole, is most often noted. On the ECG, the fluctuation of the S-T segment (usually the rise) can be observed.

To the neurovascular manifestations of the hyperventilation syndrome, most authors refer to headaches of a vascular nature, dizziness, tinnitus and other disorders. The group of peripheral vascular disorders of the hyperventilation syndrome includes acroparesthesia, acrocyanosis, distal hyperhidrosis, the phenomenon of Reynaud, etc. It should be emphasized that distal vascular disorders (angiospasm), apparently, underlie sensitive disorders (paresthesia, pain, tingling, numbness); which are considered classic manifestations of hyperventilation syndrome.

Disturbances of the gastrointestinal tract

In a special work "Hyperventilation syndrome in gastroenterology" T. McKell, A. Sullivan (1947) studied 500 patients with complaints of gastrointestinal disorders. In 5.8% of them, a hyperventilation syndrome with the above disorders was identified. There are numerous gastroenterological manifestations of hyperventilation syndrome. The most frequent complaints of a violation (usually an increase) of peristalsis, belching out air, aerophagia, bloating, nausea, vomiting. It should be noted the presence in the picture of the hyperventilation syndrome of abdominal syndrome, often found in the clinical practice of gastroenterologists, as a rule, against the background of the intact digestive system. Such cases cause large diagnostic difficulties for the internees. Quite often, patients complain of a feeling of "contraction" of the intestine, often found in patients with neuroses, in which the hyperventilation syndrome is combined with a syndrome of neurogenic tetany.

In the pathological process in the hyperventilation syndrome, other vegetative-visceral systems are involved. So, about the defeat of the urinary system is shown by dysuric phenomena. However, the most frequent sign of hyperventilation disorders is polyuria, expressed during and especially after the end of hyperventilation paroxysm. The literature also discusses the issue that hyperthermal permanent states and hyperthermia accompanying paroxysms are closely related to the hyperventilation syndrome.

Changes and disorders of consciousness

Hyperventilation lipotymia, syncope - the most vivid manifestations of cerebral dysfunction in patients with hyperventilation syndrome.

Less pronounced changes in consciousness are blurred vision, fog, mesh before the eyes, darkening before the eyes, narrowing of the visual fields and appearance of "tunnel vision", transient amaurosis, hearing loss, noise in the head and ears, dizziness, walking. The feeling of unreality is a fairly frequent phenomenon in patients with hyperventilation syndrome. It can be regarded in the context of the phenomena of the reduced consciousness, but with prolonged persistence it is legitimate to include it in the rubric of the phenomena of the altered consciousness. In its phenomenology, it is close to what is usually referred to as derealization; this phenomenon is often encountered together with other manifestations of such a plan - depersonalization. Isolated in the hyperventilation syndrome and phobic anxiety-depersonalization syndrome.

In some patients with hyperventilation syndrome, persistent, persistent phenomena of the "already seen" type can be observed, which necessitates differentiation with temporal epileptic paroxysms.

Motor and muscle-tonic manifestations of hyperventilation syndrome

The most frequent phenomenon of hyperventilation paroxysm is chill-like hyperkinesis. The shiver is localized in the hands and feet, while the patient complains of a feeling of inner shivering. Chilliness is combined with thermal manifestations in different ways. Some patients complain of a feeling of cold or heat, while an objective change in temperature is noted only in some of them.

A special place in the structure of the hyperventilation syndrome, including in the situations of paroxysm, is occupied by muscular-tonic manifestations. In our studies devoted to this issue, it was shown that the muscular-tonic tetanic (carpopedal) spasms in the structure of vegetative paroxysm are closely related to the hyperventilation component of the crisis. It should be emphasized that a number of sensitive disorders, such as paresthesia, a feeling of stiffness in the limbs, a feeling of contraction, tension, information in them, can precede convulsive muscle spasms or may not be associated with paroxysm. The tetanic syndrome (in particular, the normocalcemic, neurogenic variant of it) in patients with vegetative disorders can serve as a subtle indicator of the presence of hyperventilation manifestations. Therefore, the positive symptom of Khvostek often indicates a connection between neuromuscular excitability and hyperventilation manifestations within a certain psychovegetative syndrome.

Sensitive and algic manifestations of hyperventilation syndrome

As noted above, sensitive disorders (paresthesia, tingling, numbness, crawling sensation, etc.) are classic, specific and most frequent signs of hyperventilation syndrome. As a rule, they are localized in the distal parts of the limbs, in the face area (perioral region), although cases of numbness of all or half of the body are described. From the same group of sensitive disorders, pain sensations should be distinguished, which, as a rule, arise in connection with a sharp increase in paresthesia and the formation of muscle spasm and can be very painful. However, pain sensations often arise out of direct connection with sensorimotor tetanic disorders. Pain syndrome as such can be one of the manifestations of hyperventilation syndrome. This is evidenced by the literature data and our own observations, which made it possible to identify a fairly common combination: hyperventilation - tetany - pain. However, the allocation of pain as a separate phenomenon of chronic hyperventilation in the literature, we did not find, although such a selection, in our opinion, is legitimate. This is evidenced by the following.

First, modern studies of the phenomenon of pain have revealed, in addition to the connection with a certain organ, its independent "superorganic" character. Secondly, the pain has a complex psychophysiological structure. Within the hyperventilation syndrome, manifestations are closely related to psychological (emotional-cognitive), humoral (alkalosis, hypocapnia) and pathophysiological (increased nervous and muscular excitability), including vegetative factors. Our examination of patients with abdominal syndrome made it possible to establish the presence of hyperventilation-tetanic mechanisms in the pathogenesis of pain manifestations.

Clinically, most often the algic syndrome in the hyperventilation syndrome is represented by cardialgia, cephalgia and, as already noted, abdominal pain.

Mental manifestations of hyperventilation syndrome

Violations in the form of anxiety, anxiety, fear, longing, sadness, etc. Occupy a special place in the structure of hyperventilation disorders. On the one hand, mental disorders are part of clinical symptoms along with other somatic changes; on the other - they represent an emotionally unfavorable background on which a hyperventilation syndrome arises. Most authors note the close relationship of two interacting phenomena: anxiety - hyperventilation. In some patients, this association is so tight that activation of one component of this dyad (eg, increased anxiety in stressful situations, arbitrary hyperventilation, hyperventilation, or simply increased breathing due to mild intellectual or physical stress) can provoke a hyperventilation crisis.

Thus, it is necessary to note the important pathogenetic relationship between mental disorders and increased pulmonary ventilation in patients with hyperventilation syndrome.

[1], [2], [3], [4], [5], [6]